Negrin Lukas Leopold, Seligson David
Medical University of Vienna, Vienna, Austria.
Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Eur J Trauma Emerg Surg. 2010 Aug;36(4):369-74. doi: 10.1007/s00068-009-9081-5. Epub 2009 Nov 2.
The Kocher-Langenbeck approach is most frequently used for open reduction and internal fixation of transverse acetabular fractures, the positioning of the patient still falling to the preference of the surgeon. The impact of 'prone' and 'lateral' positioning on radiographic outcome and postoperative complication rates was evaluated by this retrospective study.
Between 2002 and 2007, 27 consecutive cases of transverse acetabular fractures were treated randomly by four attending surgeons at a Level I trauma center, 18 done in a lateral and nine in a prone position, with no significant difference in age and pre- and intraoperative parameters; no patients were excluded. The complication rate was analyzed by medical records. After an average of 9 months postoperatively, the radiographic outcome was evaluated by plain X-rays and computed tomography (CT) scans using the Matta system, the Epstein classification, and the Brooker grades. Post-traumatic arthrosis and avascular necrosis of the femoral head were documented.
We found a significantly poorer quality of fracture reduction (p = 0.032) and higher rate of posttraumatic arthrosis (p = 0.049) for patients who were operated for transverse acetabular fracture in the lateral versus the prone position. No revision surgery was needed; no infection was detected overall, whereas two iatrogenic nerve damages (one temporary, one persistent) were found only in the lateral group. There was no significant difference concerning extensive blood loss, femoral head necrosis, Epstein grades, heterotopic ossification, and secondary surgery needed.
The weight of the leg may make reduction more difficult in the lateral position, leading to a poorer radiographic outcome.
科克伦-朗根贝克入路最常用于髋臼横行骨折的切开复位内固定术，患者的体位仍取决于外科医生的偏好。本回顾性研究评估了“俯卧位”和“侧卧位”对影像学结果和术后并发症发生率的影响。
2002年至2007年期间，I级创伤中心的4位主治外科医生随机治疗了27例连续的髋臼横行骨折病例，其中18例采用侧卧位，9例采用俯卧位，年龄及术前和术中参数无显著差异；无患者被排除。通过病历分析并发症发生率。术后平均9个月后，使用马塔系统、爱泼斯坦分类法和布鲁克分级法，通过X线平片和计算机断层扫描（CT）评估影像学结果。记录创伤后关节炎和股骨头缺血性坏死情况。
我们发现，髋臼横行骨折手术采用侧卧位的患者与采用俯卧位的患者相比，骨折复位质量明显较差（p = 0.032），创伤后关节炎发生率更高（p = 0.049）。无需翻修手术；总体未检测到感染，而仅在侧卧位组发现2例医源性神经损伤（1例为暂时性，1例为持续性）。在大量失血、股骨头坏死、爱泼斯坦分级、异位骨化和所需二次手术方面无显著差异。
侧卧位时腿部重量可能使复位更加困难，导致影像学结果较差。
